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Dr. Kalantariis the associate program director of the emergency medicine residency at Penn State Health Milton S. Hershey Medical Center, an international speaker and author on physician wellness, a faculty mentor for the ALiEM Wellness Think Tank, a member of the American Academy of Emergency Medicine Wellness Committee, and a speaking coach for FemInEM. Follow her on Twitter @akkalantari.

Humans are remarkable creatures. We have survived wars, natural disasters, famines, personal loss, and disease, yet we still find a way to make connections and find happiness. Some of us are debilitated by wounds that won't heal, but some heal and thrive with scars. I believe the difference is a result of stress-growth, the increasing emotional strength from adversity or mental stress. It's the way we thrive with scars rather than be debilitated by wounds.

Stress-growth is different from resilience. Resilience is the capacity to recover quickly from difficulties, the ability of a substance or object to spring back into shape. You do not return to your baseline shape after an event with stress-growth; you are stronger as a result of it. This is especially important for those of us on the front lines of health care. Think of how many times we had to deliver devastating news. How many times we had to deal with death and severe disease? And we do that on top of our personal lives.

Three steps are essential to achieving stress-growth: developing a stress mindset, using vulnerability appropriately, and building grit, but let's focus on the stress mindset.

The Positives of Stress

Stress is _____. What was your initial thought? The majority of people with whom I've discussed this topic filled in that blank with something negative, terms like “bad,” “divorce,” “death.” But step outside of the context of emotional stress. The stress of weight-bearing makes bones and muscles grow stronger; the stress of cardiovascular exercise benefits the heart and lungs. These are the positive effects of stress, but talking about emotional stress makes all positive thoughts vanish. It is not our fault; we have been conditioned to feel this way.

Most of what we know about the physiologic effects of stress comes from studies done on rats in the 1930s. Hans Selye, MD, injected rats with ovarian extract and noticed they developed ulcers, their immune systems suffered, and then they died. That was when the idea of stress causing health problems was born.

We've also been taught to think stress equals fight or flight. This concept came from Walter Cannon, MD, who in the early 1900s pitted cats and dogs against each another. He measured their vital signs, physiologic changes, and catecholamines, and called the response fight or flight. Humans are a bit more complex in their stress responses. We have fight or flight, but other responses to stress also occur.

Stress Responses

The challenge response increases our self-confidence, motivates us, helps us learn from experience, gives us energy, and helps us perform under pressure. This response is driven by DHEA and benefits resilience and learning. The tend-and-befriend response increase courage, motivates caregiving, and strengthens relationships; it is driven mainly by oxytocin. It enhances empathy and intuition, and leads us to seek friendship during times of stress. It motivates social connection, building of social networks, and dampens fear responses. Oxytocin also happens to be cardioprotective.

Alia Crum, PhD, and Kelly McGonigal, PhD, have published several studies and written some great books that discuss changing your mindset about stress and the long-term social and health benefits. Dr. McGonigal's book, The Upside of Stress, provides tons of data to support the benefits of stress and goes through several exercises to help the reader build a stress mindset.

Carol Dweck, PhD, in Mindset: The New Psychology of Success, explained the growth mindset and fixed mindset. The growth mindset allows us to cultivate ourselves in any field with effort, consider failure a learning opportunity, and seek challenges so we can grow. A fixed mindset means individuals believe the qualities they have at birth stay the same for the rest of our lives; they avoid challenges for fear of failure. She offers essential pointers on how to shift one's mindset from a fixed perspective to a growth perspective.

Stress is not the enemy. Take a step back and evaluate your response when you are feeling stressed. Is this the response you want to have? If not, think about which response you would like and work on it. This will help you build a stress mindset, and that is the first step in thriving with scars.

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